An Economic Evaluation Supported by Qualitative Data About the Patient Concerns Inventory (PCI) versus Standard Treatment Pathway in the Management of Patients with Head and Neck Cancer

Abstract

Background The head and neck cancer (HNC) Patient Concerns Inventory (PCI) is a condition-specific prompt list that allows patients to raise concerns to cancer consultants that otherwise might be overlooked. Objective This is the first economic evaluation of the PCI in patients with HNC investigating the costs and effects to the health service of not prioritising certain treatment pathways in addition to the primary cancer pathway. Additional costs can be accrued due to delayed referral to other appropriate services, e.g. hospital dentist. Economic evidence could influence future policy direction in this area globally. Methods Alongside a 3-year clustered randomised controlled trial, an economic evaluation was undertaken with Client Service Receipt Inventory data collected at three different time points (baseline and 6 and 12 months post-baseline). Patients were identified by a multidisciplinary team at the trial clinics. This economic analysis compared the PCI intervention versus the non-PCI treatment pathway. A deterministic and probabilistic sensitivity analysis was conducted to investigate the cost per quality-adjusted life-year (QALY) gain of the PCI versus non-PCI intervention treatment pathways. Qualitative data were also collected from seven consultants to triangulate findings from the economic evaluation. Results The analysis used data from 191 patients (66% of the full trial sample). The PCI inventory was low cost, at just over £13 per participant. The PCI intervention was cost effective and also cost saving, with an incremental cost difference of £295.91 over the 12-month follow-up period. The QALY values were higher in the PCI intervention strategy, with a value of 0.79, whereas the non-PCI group had a value of 0.76, thus the PCI intervention was dominant. The sensitivity analysis showed that, at a willingness-to-pay threshold of £20,000 per QALY gained, the probability of being cost effective was 0.85 (95% confidence interval [CI] 0.80–0.83). Qualitative results showed that consultants using the PCI reported an enhanced awareness of patients’ overall post-treatment needs. Discussion The PCI provided an effective means to conduct clinical consultations by avoiding unnecessary healthcare costs and focussing on aspects of care most important to patients. The cost per QALY gain was within the National Institute for Health and Care Excellence guideline threshold. The economic evaluation showed that the PCI intervention strategy was dominant and therefore cost saving to the national health service (NHS) and was more effective in terms of treatment. Conclusion The PCI appears to be a low-cost intervention that generates a cost-effective benefit to patients from a NHS perspective if rolled out as part of routine care. Qualitative evidence has shown that the use of the PCI is supported by consultants in routine practice. Trial Registrat...

The Patient Concerns Inventory in head and neck oncology: a structured review of its development, validation and clinical implications

“…Pain was a major dysfunction (63%) as was physical and social-emotional functioning and this group reported many PCI issues, median (IQR) 7 (4–11) 7 Dimelow et al (2021) [ 51 ] A prompt list sent out to the patient in advance of the consultation (Patient Concerns Inventory) could be a useful adjunct in telephone consultations 3, 4 Elaldi et al (2020) [ 18 ] Identification of patient needs and concerns along with multidisciplinary management of persistent symptoms and psychological distress seem essential steps towards improving QoL of HNSCC patients. 6 Ezeofor et al (2022) [ 44 ] The PCI appears to be a low-cost intervention that generates a cost-effective benefit to patients from a UK National Health Service (NHS) perspective if rolled out as part of routine care. Qualitative evidence has shown that the use of the PCI is supported by consultants in routine practice.…”

“…Secondary exploratory analyses indicated that HRQOL status early after the completion of treatment was the dominant predictor of HRQOL after another 12 months and the trend in analyses over a range of outcomes suggests that patients with worse early HRQOL could benefit more from the PCI–HN. The PCI–HN is a low-cost intervention which generates a cost-effective benefit to patients from an NHS perspective if rolled-out as part of routine care [ 44 ]. The trial findings indicated that a pragmatic multi-unit cluster trial for a study of this nature was feasible, and it has helped increase the profile of this type of approach in clinical care as well as increasing the body of evidence with publications in peer review journals.…”

Concerns raised by people treated for head and neck cancer: a secondary analysis of audiotaped consultations in a health services follow-up clinic

“…This is the first study to investigate the impact of introducing the PCI pre-consultation on specific communication events regarding patient concerns during HNC follow-up consultations. Our previous work has reported the main effects of PCI usage on QoL [ 24 ] and an economic evaluation [ 25 ]. Results of this current study show a significant difference in number of concerns raised between trial groups, where patients in the PCI group raised on average 2.5 more concerns than non-PCI patients.…”

Addressing patients’ concerns in speech and language therapy consultations following the diagnosis and treatment of head and neck cancer

“…The Patient Concerns Inventory-Head and Neck (PCI-HN) is a condition-specific item prompt list, which patients select from before their appointment, to help guide the outpatient consultation, and has been shown in a randomised trial to improve outcomes [52] and be cost-effective [53]. It has been reported to be the most appropriate tool specific to HNC with a particular emphasis on the importance of content validity over quantitative psychometric properties [51].…”